Autism insurance coverage at the rate of 20,000 per year would result in an insurance premium increase of $2.18 per month for the average family.

A review/summary of: James N. Bouder, Stuart Spielman, David S. Mandell (2009). Brief Report: Quantifying the Impact of Autism Coverage on Private Insurance Premiums Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-009-0701-z

Health care expenditures for children with autism and other ASD are disproportionally absorbed by families as compared to expenditures for children with other chronic developmental or medical conditions. This is mostly due to the reluctance by many insurance companies to pay for services needed for children with autism. This has led many States in the USA to consider enacting laws mandating insurance companies to cover services for children with ASD. Yet, opponents (mostly the insurance companies) argue that such laws would result in significant increases in insurance premiums for all families.

The current study examined data from Pennsylvania, which requires insurance companies to pay for up to $36,000 per year in services for children with ASDs from birth to the age of 21.

The authors estimated the impact on insurance premiums using a formula that took into account 1) the prevalence of autism, 2) the number of insured children in Pennsylvania, 3) the average medical expenditure for children with ASD, 4)the % of revenues of insurance premiums actually spent on paying for services, and 5)the total revenues obtained by the private insurance companies.

The results indicate that based on an average insurance premium per family of $1,009 per month (combined employer and employee contribution):

An average of $10,000 annual expenditures per eligible child would result in an increase of $0.54 per month to the average family’s premium contribution. That is, if all eligible children spent $10,000 per year, the average family would see a premium increase of 54 cents per month.

An average of $20,000 annual expenditures per eligible child would result in an increase of $2.18 per month to the average family’s premium contribution.

An average of $36,000 annual expenditures per eligible child would result in an increase of $6.53 per month to the average family’s premium contribution.

Uncharacteristically political commentary:
I would say I do not have a problem with insurance companies refusing to pay for experimental treatments that have no empirical support (being this for autism or any other condition), but I do not understand the argument that insurance companies should be permitted to selectively refuse treatment for “costly” or “chronic” conditions. The argument that providing services for children with autism would increase premiums for all is utterly ridiculous. All conditions contribute to the cost of insurance premiums. Providing services for asthma, depression, migraines, adhd, seizures, etc, etc, contribute to the cost of our premiums, so using the insurance companies’ logic these conditions should not be covered! We should not selectively pick which conditions we support with our premiums, just as we do not selectively pick which conditions our kids may or may not develop.

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